In vitro activity of itraconazole against fluconazole-susceptible and -resistant Candida albicans isolates from oral cavities of patients infected with human immunodeficiency virus

Barchiesi, Francesco; Colombo, Arnaldo Lopes; McGough, D A; Fothergill, Annette W.; Rinaldi, Michael G.

doi:10.1128/aac.38.7.1530

Cited by 80 publications

(46 citation statements)

References 18 publications

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“…Interestingly, the MIC of 2 ,ug/ml for D0870 is very close to the susceptibility patterns reported by Peng and Galgiani (10) for C. kwusei and T. glabrata, two species with frequently reported in vitro as well in vivo azole resistance (1,18,20). Our results confirm those previously reported from the testing of itraconazole against fluconazole-susceptible and -resistant C albicans isolates in this group of patients (2). Some of the isolates tested in the present study were previously tested with itraconazole.…”

Section: Discussionsupporting

confidence: 82%

In vitro activity of a new antifungal triazole, D0870, against Candida albicans isolates from oral cavities of patients infected with human immunodeficiency virus

Barchiesi

Colombo

McGough

et al. 1994

Antimicrob Agents Chemother

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We investigated the in vitro activity of a new antifuingal triazole, D0870, against 100 Candida albicans isolates from the oral cavities of patients infected with human immunodeficiency virus by using a broth macrodilution method following the recommendations provided by the National Committee for Clinical Laboratory Standards (document M27-P). All (4,8,10,21). No data are available about its in vitro activity against Candida albicans isolates from the oral cavities of human immunodeficiency virus (HIV)-infected patients. In the last few years the development of fluconazole-resistant isolates of C. albicans in these patients has been reported (3,5,11,15,19). The lack of standardized methods for in vitro antifungal susceptibility testing presents difficulties in recognizing isolates with reduced susceptibilities to the antifungal agents (12,13 (210) 567-4076. the oral cavities of HIV-infected patients were used in the study. Each strain represented a unique isolate from a patient. All of the strains were chosen from among C. albicans isolates already tested for fluconazole susceptibility by the NCCLS procedure (9). In order to obtain isolates of C. albicans with different patterns of in vitro susceptibility to fluconazole, we included 50 isolates for which the fluconazole MICs were s4 ,ug/ml, which were considered susceptible (group A), and 50 isolates for which the fluconazole MICs were .8 p,g/ml, which were considered resistant (group B) (Fig. 1). All of the isolates were tested for susceptibility to D0870 in a blind and random fashion by a broth macrodilution method following the recommendations provided by NCCLS (9). Two reference strains, C.

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Section: Discussionsupporting

confidence: 82%

In vitro activity of a new antifungal triazole, D0870, against Candida albicans isolates from oral cavities of patients infected with human immunodeficiency virus

Barchiesi

Colombo

McGough

et al. 1994

Antimicrob Agents Chemother

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“…The increasing resistance of C. albicans from HIVinfected patients undergoing long-term fluconazole therapy has become a major problem (Barchiesi et al, 1994;Ruhnke et al, 1994;Rex et al, 1995a). Further, the recent discovery of C. albicans resistance to other antifungal drugs, such as amphotericin B and the other azoles, is worrisome (Kelly et al, 1996;Le et al, 1996;White et al, 1998).…”

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confidence: 99%

Oral Candidal Infections and Antimycotics

Ellepola

Samaranayake

2000

Critical Reviews in Oral Biology & Medicine

208

236

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The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidoses. One form of the latter presents classically as a white lesion of "thrush" and is usually easily diagnosed and cured. Nonetheless, a minority of these lesions appears in new guises such as erythematous candidosis, thereby confounding the unwary clinician and complicating its management. Despite the availability of several effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon due to the unique environment of the oral cavity, where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. This problem has been partly circumvented by the introduction of the triazole agents, which initially appeared to be highly effective. However, an alarming increase of organisms resistant to the triazoles has been reported recently. In this review, an overview of clinical manifestations of oral candidoses and recent advances in antimycotic therapy is given, together with newer concepts, such as the post-antifungal effect (PAFE) and its possible therapeutic implications.

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“…Amphotericin B deoxycholate has been the standard recourse for patients infected with Candida sp. unresponsive to azole therapy (5,10,24,36). The use of conventional amphotericin B preparations is complicated by its significant toxicity.…”

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confidence: 99%

Randomized, Double-Blind, Multicenter Study of Caspofungin versus Amphotericin B for Treatment of Oropharyngeal and Esophageal Candidiases

Arathoon

Gotuzzo

Noriega

et al. 2002

Antimicrob Agents Chemother

245

156

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Caspofungin is an antifungal agent of the novel echinocandin class. We investigated its efficacy, safety, and tolerability as therapy for oropharyngeal and/or esophageal candidiasis in a phase II dose-ranging study. Patients were randomized in a double-blind manner to receive either caspofungin acetate (35, 50, or 70 mg) or amphotericin B (0.5 mg/kg of body weight) intravenously once daily for 7 to 14 days. A favorable response required both complete resolution of symptoms and quantifiable improvement of mucosal lesions 3 to 4 days after discontinuation of study drug. Efficacy was assessed using a modified intent-to-treat analysis. No hypothesis testing of efficacy was planned or performed. Of 140 enrolled patients, 63% had esophageal involvement and 98% were infected with the human immunodeficiency virus (HIV) (median CD4 count, 30/mm 3 ). A modestly higher proportion of patients in each of the caspofungin groups (74 to 91%) achieved favorable responses compared to amphotericin B recipients (63%), but there was considerable overlap in the 95% confidence intervals surrounding these point estimates. Similar trends were found in the subgroups with esophageal involvement, a history of fluconazole failure, and CD4 counts of <50/mm 3 . A smaller proportion of patients receiving any dose of caspofungin experienced drug-related adverse events compared to patients given standard doses of conventional amphotericin B (P < 0.01). Caspofungin provided a generally well-tolerated parenteral therapeutic option for HIV-infected patients with oropharyngeal and/or esophageal candidiasis in this study.Mucosal candidiasis, although not life-threatening, causes significant morbidity in patients infected with the human immunodeficiency virus (HIV) (16). The development of drug resistance in the causative strain or the selection of intrinsically more resistant species may complicate therapy of recurrent candidal infections (19,20,28,34,36,40,43). This study describes the use of a new echinocandin, caspofungin (Cancidas; formerly MK-0991), as treatment for oropharyngeal and esophageal candidiasis in an immunocompromised patient population.Oral fluconazole is widely regarded as the treatment of choice for mucosal candidiasis under most circumstances (36). Amphotericin B deoxycholate has been the standard recourse for patients infected with Candida sp. unresponsive to azole therapy (5,10,24,36). The use of conventional amphotericin B preparations is complicated by its significant toxicity. Newer lipid formulations of amphotericin have reduced, but not eliminated, some of these adverse effects (15).Caspofungin possesses activity in vitro (6,17,23,30,31,42) and in vivo (1, 2, 11, 13) against a variety of fungal pathogens, including Candida and Aspergillus species. Echinocandins noncompetitively inhibit 1,3-␤-D-glucan synthesis, interfering with the normal formation of the fungal cell wall (3). Since glucans are not present in mammalian cells, it is hoped that echinocandins will have a relatively high therapeutic index. Crossresistance with...

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In vitro activity of itraconazole against fluconazole-susceptible and -resistant Candida albicans isolates from oral cavities of patients infected with human immunodeficiency virus

Cited by 80 publications

References 18 publications

In vitro activity of a new antifungal triazole, D0870, against Candida albicans isolates from oral cavities of patients infected with human immunodeficiency virus

In vitro activity of a new antifungal triazole, D0870, against Candida albicans isolates from oral cavities of patients infected with human immunodeficiency virus

Oral Candidal Infections and Antimycotics

Randomized, Double-Blind, Multicenter Study of Caspofungin versus Amphotericin B for Treatment of Oropharyngeal and Esophageal Candidiases

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